Question on process

[wweir]

I have a question on process. So far I have been diagnosed, AVR, had the TEE and the heart catheritzation (arteries are clear).

My surgeon is a Dr. Jex, at the Nebraska Heart Institute here in Lincoln. They provide complete cardiac, thoracic, vascular and organ transplant care.

The Institute has a team of expert cardiologists and surgeons of NHI perform more diagnostic, interventional, and surgical procedures than any other cardiac program in the state. They claim that they have performed over 1,500 open heart surgeries, 6,500 heart catheterizations, and 1,700 interventional procedures.

So I hade my ?consultation? and Dr. Jed recommended that I get this done in the next few months. My question is what the normal sequence of events is. I guess I just call and make a date. What normally happens next?

Are their things I should be doing? Contacting insurance companies? I am a retired LTC/US Army and I have BC/BS. Are most things covered?

The whole issues of what valve to get are enough to drive you crazy. The more I read about St Jude vs. ATS vs. Pig the more I am confused. The thought of Coumadin is not appealing but the thought of multiple surgeries is worse.

I also read that the way to proceed is come up with a list of this first and this second so the surgeon has some options once he is in there.

Your help and insight is much appreciated.

 

[Ross]

I'll take a stab at this one.

First you go through all the diagnostics, which it appears you have done.
Then it's on to seeing the surgeon and discussing your concerns, type of valve, etc.
Then on to making a surgical date.
Then Pre-Admission Testing
Then The surgery.

In the back ground, you may want to dig up your insurance policies and check what all is and isn't covered. Blood being one of the many items. If you need pre-authorizations, be sure to get them. Don't give the Insurance companies any chance to deny claims for silly reasons.

Depending on your age and physical condition, valve selection may be easy. They don't want to have to go in again, unless absolutely necessary and the more surgeries you have the more difficult recovery becomes.

In my case, we've decided to go with the St. Jude Mechanical with graft as a first choice. If anatomically this can't be, then a Bovine or Porcine Tissue valve will be used. The surgeon won't know until he's in there.

Coumadin is not a big deal. It's sort of like taking your daily vitamin and being consistant in your diet. Once things are stabilized, it's not an issue. If you go this route, try to get the home INR testing unit. I plan on doing the same.

Take care of any home issues you may have, such as your Will, Living Will, etc. in the event things would go terribly wrong. I'm not trying to scare you, just prepare you.

If I've left something out, I'm sure someone will jump in and correct me. If you think of anything else, ask away.

 

[ALCapshaw]

The numbers you cite for your local hospital don't sound terribly high.
I would ask the surgeon how many valve replacements HE performed in the last year or last 12 months, how many of the same valve, how many other heart surgeries, etc. Active surgeons perform around 200 per year. Also, ask how many heart surgeries are performed by the Hospital per year. Hospitals that perform over 1000 heart surgeries per year typically have better statistics than ones that perform fewer.

You may be able to find ratings on your hospital, by procedure, by looking them up at www.HealthGrades.com

The highest rated heart hospital in the country is the Cleveland Clinic.
US News has a ranking list of heart hospitals on their website.

I chose to have my Valve Replacement surgery at the very highly rated University of Alabama at Birmingham (100 miles away) because of it's excellent reputation for complex heart surgeries (valves and transplants) vs. our local hospital which does very well with angioplasties and bypass surgeries.

'AL'

 

[wweir]

Thanks

Thanks

Ross, Al, and everyone else, you all are a wealth of knowledge and information. I should buy you all a drink.

I found my doctor attended medical school at the University of Utah, Salt Lake City, UT and residency at the Mayo Graduate School, in Rochester MN. His primary specialty is Heart Surgery (Cardiothoracic Surgery). I also found that the hospital Bryan LGH East, here in Lincoln, in 2001 was rated five stars and in 2002 they were rated three stars but they were actually better than expected. I did note that they do more of these procedures than anyone else in Nebraska.

Did either of you do any exercises or diets in anticipation of all this? Did you do any dental work ahead of time?

You all make me feel much better knowing I can talk about these things with folks who are going through the same situation, Thanks again for helping me eliminate the fear.

Ths whole thing still is still unreal to me.

Walter

 

[Ross]

I haven't done anything exceptional, as far as exercise. If you can excercise, I'd recommend it. Walk around a local mall-Anything to build your lung capacity up and strengthen your heart as much as possible.

Of course, I'm somewhat limited to sedentary activity anyhow.
As for the dental work-Yes, anything that needs done should be done before surgery. If you have Wisdom teeth that need pulled, have that done. I had 4 fillings that needed fixed/replaced, so now I'm good to go.

Eliminating of the fear?
I don't think any of us truly do.
We've come to understand that we have NO control over our conditions and have to rely on something more then ourselves.

Walter, when I came to this site, I was exactly where you are now. You can try to talk to other people who've never had heart problems or surgery, but they just don't get it. You wind up feeling like your facing this alone. This is why this site is unique. We've all been there and find solice in talking to others in the same situations.

This time around for me, I've decided to stay local rather then going to Cleveland again. The surgeon I have at our local hospital was somewhat stolen from the CCF anyhow. He's turned the entire Cardiac floor into his domain and brought about major change at the hospital. I'm comfortable with him. I guess what I'm trying to convey here, is that you don't have to go to a major hospital to get excellent care. I would check with any previous patients, where you plan to go, to see how their experience was at the facility. I checked with a couple of people where I plan on going, and they both said that the staff went far above and beyond the call of duty in their cases.

You and I share another interest---Flying!
Maybe we can converse on that sometime.

 

[Marty]

Enemas till clear!!!

Enemas till clear!!!

Ross has covered most points very well. I was surprised when my pre op instructions included nothing about a bowel prep. In my days as a house officer 50 plus years ago we would never do any kind of operation without a bowel prep- cleaning the patient out. We would have the patients take laxatives and then the night before the surgery write an order"enemas til clear". So on my own 48 hours before my mitral valve replacement I took the Fleets Phospho soda prep. I took nothing the night before the surgery as I had to be at the hospital at 5:00 AM. Any how I think the prep helped me post op. One thing I was not worrying about was my bowels. I went home feeling good the AM of the 4th post op day.Check with your surgeon about this. Maybe you young guys are no problem.

 

[Ross]

Funny that you brought that up Marty.
I've been wondering about that myself for a good while now.
Not that I want one or care for them any. Though I'd welcome that more then an NG tube or Foley catheter.
Can anyone elaborate on this a little more?

 

[Marty]

Catheter anyone?

Catheter anyone?

They take out the Foley( its got a balloon to anchor it) when they think its time for you to go on your own. If you don't as I didn't you get a regular one time catheter. That inspired me and I didn't need another one.This can be a problem mostly for men particularly old men.

 

[Nancy]

Joe has never had a bowel prep for any of his surgeries that I can remember. After all of them he always was given Colace and maybe something else if there were no bowel sounds for a while.

He usually had a Foley inserted except for some of the more minor surgeries.

 

[Ross]

Must be a thing of the past. When they called me with the surgery time (The canceled date) they never once mentioned anything about enemas, just no eating or drinking after midnight.

Hows come everyone is avoiding the nasogastric tube?
I hate it as much as the darn Foley! Too bad they don't put those in when your sedated and couldn't care less.

 

[Nancy]

They did the ng tube when you were awake??? Were you a naughty boy or something?I don't think Joe's ever had that done when he was awake. He surely would have mentioned that. He's mentioned the Foley but never the ng tube.

 

[Ross]

Nancy, you know I'm always naughty and ornery, but I didn't do anything to deserve the tube awake.

I think my hospital is a little into the pain thing. lol
Yeah, I was quite conscience and not even close to going down to surgery. Talk about clear your head out!

I really can't see why they can't put the Foley in after your out either. Just seems kind of unnecessary to me.

 

[Nancy]

What would happen if you requested them to do those things when you were out. Tell them you're phobic.

 

[JenniferO]

Just a comment on cardiac training at University of Utah. In preparation for my own heart surgery (mitral valve prolapse and severe regurgitation), I consulted with two of our best heart surgeons here in Salt Lake City. We always thought and heard that "the U" was a first rate, progressive medical school and training facility. After all, the first artificial heart was implanted in Barney Clark at the U and a lot of the early heart transplant work was also done here. (I can't remember the name of the prominent surgery who later went to Texas; but there was a lot of significant early work done here). The first surgeon I consulted was Dr. Karwande, head of cardio-thoracic surgery at the University of Utah and locally considered a "god" when it comes to heart surgery. Unfortunately, he could only give me 50-70% odds he could repair my valve. He was a very straight shooter and I really came to like and respect him for his straightfowardness; however, it became clear that he does all sorts of cardiac procedures (including heart transplants) and therefore cannot claim to be a specialist in any particular one. He attempts 2-3 mitral valve repairs per month, of which not all are successful. I then consulted with Dr. Donald Doty at LDS Hospital in Salt Lake, a national specialist in the Ross Procedure and a surgeon with more than 40 years experience, authored a cardiac surgery textbook, etc. Also very well-respected like Dr. Karwande. He also only attempts 2-3 mitral valve repairs per month, of which many become replacements. Dr. Doty directed me to Dr. Cosgrove at Cleveland Clinic for higher odds. Dr. Cosgrove does 4 valve repairs PER DAY and gave me a 95% chance of repair. It took an appeal to my insurance company, but I went to Cleveland and I got my repair. All doctors at my local end say it was an excellent repair and that I made the right decision (though I have not been without some post-op problems). Just offer this for a perspective on settling for your local doctor vs going for the high volume experts.

 

[Ross]

I tried, to no avail back then. Maybe this too, this is a thing of the past? If not, I can take it, but I don't have to like it.

 

[Johnny Stephens]

No enemas in prep

No enemas in prep

I did not get the enema treatment before my surgery.

I really didn't mind the Foley all that much as long as people didn't touch it They put it in while I was out.

22yrs ago I had a splenectomy (Hodgkin's staging) , and they put in the NG tube while I was awake. The worst procedure I've ever endured, bar none, recent surgery included.

 

[joy]

I was learning how to walk and tripped over one of my foley catheters. Now THAT hurt! What's an NG tube? Just wondering.

 

[Nancy]

It's short for nasal-gastric tube. They thread it up your nose and down your throat into your stomach. It's attached to a suction type collection bottle. Get's rid of stomach nasties and helps so you don't get nauseous after surgery, and probably helps in case you might regurgitate things and choke when you're groggy.

Sorry to be so graphic..

 

[John & Joann]

Hi Friends!

Joann is the old lady of the group--30.5 years with 2 mechanical valves.

We both let the doctor select the type and brand of valves. We are TOTALLY sold on Cleveland Clinic. In 1971 they were doing 8 bypass and 1 valve per day. Today the number is MUCH higher. They are the leading facility for valve surgery. Their success rate is very high.

You are not only selecting a surgeon, but an entire team. These folks have bad days, hangovers, headaches, etc. There are others that can take their place. Each team learns from the others.

Other facilities are also good, but it is very important to have the surgery at a location that does this on a regular schedule. You do not need a surgeon to read the installation manual during the procedure.

God Bless!

John & Joann
Baking in Western Ohio

 

[Ron K]

PMA

PMA

Hi Walt,

I just got back from a couple of weeks of vacation and saw your post as I was catching up on this wonderful site. I wish you had posted a couple of weeks ago. I could have met with you last week. I was visiting relatives in the Lincoln area (Palmyra and Unadilla). We had a good time out there. You live in a nice part of the counrty.

Anyway, I wanted to tell you that I'm about 3 years older than you are and I have an aortic valve replacement in February. I opted for the bovice pericardial tissue valve. I did very well and I'm feeling great. The surgery wasn't bad and the recovery period was much better than I thought it was going to be.

My advice is to try to be in the best shape you can before the surgery. Do a lot of walking if you can. Get some kind of arobic excersice program started. It will help greatly during the recovery period.

Also, do everything you can to keep a positive mental attitude. Focus on how good you're going to feel in 6 or 8 weeks after surgery. Think about the relief you'll have not worrying about your cardiatric condition getting worse as time goes by. Think about the years you'll be adding to your life--years you'll have to spend with family, friends and loved ones. Start planning the special trip that you've always wanted to take, but kept putting off. Dream about the wonderful retirement years ahead. The odds are overwhelmingly in favor of a very successful outcome for you, so stay optimistic.

By the way, my surgeon's secretary was very helpful in handling the details with the insurance company, telling me the procedures for donating blood, helping my wife make reservations in the hotel across the street from the hospital, etc. I didn't encounter any problems in the pre-surgery process.

I hope this helps a little.

Ron K